NUTRITION COUNSELING PRACTICES IN THE EYE CARE SETTING

Atrium

Objective. The primary aim of this project was to ascertain eye care practitioners' current trends regarding nutritional counseling for patients, and to identify potential barriers to its widespread practic. A secondary goal was to increase awareness of the need for nutritional counseling for patients with various ocular conditions, including age-related macular degeneration (AMD), glaucoma, diabetes and related eye disease, dry eye syndrome/ocular surface disease, and cataracts. Background. Type II diabetes mellitus (DM) is another urgent public health concern; it is estimated that currently, 40% of U.S. adults is either diabetic or "pre-diabetic." If current trends continue, that number may reach 50% by the year 2020. The cost of caring for diabetic patients is estimated to reach $500 billion annually by that time. Since Type II DM is nearly entirely a preventable illness, it is essential that every member of the health care delivery team participate in measures to reduce the incidence of this disease. Further, it is well-established that the incidence and severity of diabetic retinopathy are closely linked not only to blood sugar control, but also to other nutritional factors such as vitamin D insufficiency and deficiency. Cataract removal is one of the most prevalent surgical procedure performed in the U.S. today (AHRQ.gov http://www.hcup-us.ahrq.gov/reports/statbriefs/sb86.jsp), representing a large proportion of health care dollars. Non-invasive interventions - including body weight management, smoking cessation, limiting UV exposure, and appropriate nutritional intake - have the potential to delay the onset and/or severity of cataracts. (separate sheet reference list) PLUS our 20 It is clear that the connection between sub-optimal nutrition and an increased prevalence of ocular disease is well-established in the literature. Despite the impressive volume of scientific literature in these, informal data suggest that many eye care providers do not routinely discuss this important aspect with their AMD patients (10,21), and even when vitamin supplements are recommended by eye care providers, patients with AMD often do not understand the importance of such supplementation (13). Far fewer practitioners discuss the connection between nutrition and glaucoma with their patients. Perhaps more importantly, much data supports the preventative benefit of adequate nutrient intake in these 65 and other ocular conditions, in addition to the potential use of nutrition and supplementation in complementing traditional medical therapy once patients have developed the disease. Unfortunately, the frequency of patient education efforts for those individuals who may be at risk for the development of many age-related conditions is likely even less than for patients who are already diagnosed. Methods. A link to an anonymous, web-based survey instrument was sent to 35,000 eye care practitioners who had email addresses registered with the Jobson Group's Review of Optometry publications. The survey instrument (Figure 1) was designed and adminstered on Nova Southeastern University's proprietary Opinio® software, after obtaining IRB exemption for the work. The survey remained open for 12 months. A total of 636 responses were captured and analyzed. Results. 83% of doctors surveyed make nutritional recommendations at least some of the time to their patients. Primary factors influencing the decision to counsel or not counsel include medical history, family history, smoking status, and age. Recommendations for omega-3 fish oil supplementation for dry eye patients is the most common counseling achieved in the optometric practice, while recommendations for patients with macular degeneration, glaucoma, diabetes, and hypertension are less frequent. Barriers to not counseling patients are many, but the primary influence is a lack of understanding and information for the practitioner to feel competent in making such a recommendation. Conclusion. Optometrists need better access to trustworthy information and education regarding the potential benefit of nutrition and lifestyle counseling and ocular disease. A lack of understanding and knowledge is a significant barrier to optometrists routinely making these recommendations in clinical practice. Grants. This study was supported in part by an HPD Research grant.